African nurses and everyday work in twentieth-century Zimbabwe

By Clement Masakure

Informed by the memories of African nurses, this book highlights the experiences of men and women who provided nursing services in Zimbabwe’s hospitals in the twentieth–century. It argues that in their subordinate positions, and within their various capacities – nursing assistants, nursing orderlies, medics and qualified nurses - African women and men played a pivotal role in the provision of healthcare services to their fellow Africans. They transformed hospital spaces into their own, reshaped and reformulated indigenous as well as western nursing and biomedical practices. Through their work, African nurses contributed to the development of the nation by being at the bedside, healing the sick and nursing the infirm.

• Language: English
• Publisher: Manchester University Press
• Release date: Dec 15, 2020
• ISBN: 9781526135490

Book preview

African nurses and everyday work in twentieth-century Zimbabwe

Series editors: Christine E. Hallett and Jane E. Schultz

This series provides an outlet for the publication of rigorous academic texts in the two closely related disciplines of Nursing History and Nursing Humanities, drawing upon both the intellectual rigour of the humanities and the practice-based, real-world emphasis of clinical and professional nursing.

At the intersection of Medical History, Women’s History and Social History, Nursing History remains a thriving and dynamic area of study with its own claims to disciplinary distinction. The broader discipline of Medical Humanities is of rapidly growing significance within academia globally, and this series aims to encourage strong scholarship in the burgeoning area of Nursing Humanities more generally.

Such developments are timely, as the nursing profession expands and generates a stronger disciplinary axis. The MUP Nursing History and Humanities series provides a forum within which practitioners and humanists may offer new findings and insights. The international scope of the series is broad, embracing all historical periods and including both detailed empirical studies and wider perspectives on the cultures of nursing.

Previous titles in this series:

Mental health nursing: The working lives of paid carers in the nineteenth and twentieth centuries

Edited by Anne Borsay and Pamela Dale

Negotiating nursing: British Army sisters and soldiers in the Second World War

Jane Books

One hundred years of wartime nursing practices, 1854–1953

Edited by Jane Brooks and Christine E. Hallett

‘Curing queers’: Mental nurses and their patients, 1935–74

Tommy Dickinson

Histories of nursing practice

Edited by Gerard M. Fealy, Christine E. Hallett and Susanne Malchau Dietz

Nurse writers of the Great War

Christine Hallett

Beyond Nightingale: Nursing on the Crimean War battlefields

Carol Helmstadter

Who cared for the carers? A history of the occupational health of nurses, 1880–1948

Debbie Palmer

Colonial caring: A history of colonial and post-colonial nursing

Edited by Helen Sweet and Sue Hawkins

Ellen N. La Motte: Nurse, writer, activist

Lea M. Williams

AFRICAN NURSES AND EVERYDAY WORK IN TWENTIETH-CENTURY ZIMBABWE

CLEMENT MASAKURE

Manchester University Press

Copyright © Clement Masakure 2020

The right of Clement Masakure to be identified as the author of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

Published by Manchester University Press

Altrincham Street, Manchester M1 7JA

www.manchesteruniversitypress.co.uk

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN 978 1 5261 3547 6 hardback

First published 2020

The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Cover image: Treatment of leprosy (courtesy National Archives of Zimbabwe)

Typeset by Newgen Publishing UK

For my family

Contents

List of figures

List of tables

Acknowledgements

Map

1Introduction: African nurses in Zimbabwe’s hospitals

2The experiences of the pioneer generation of nurses, c. 1900–49

3‘Our kitchen days are over … We can no longer continue the tradition of our predecessors’: Taking up nursing as a career option, c. 1950 to the 1960s

4The Africanisation of Rhodesia’s clinical spaces and an anatomy of everyday work in hospitals, 1960–70

5Nursing a nation at war: Nurses’ experiences during the 1970s

6The trajectories of nursing in independent Zimbabwe, 1980–96

7Conclusion: Nurses and nursing in twentieth-century Zimbabwe

Appendix 1: Colonial and post-colonial names

Appendix 2: Explanations and translations

Bibliography

Index

Figures

Every reasonable attempt has been made to obtain permission to reproduce copyright images. If any proper acknowledgement has not been made, copyright holders are invited to contact the author via Manchester University Press.

2.1An early mission station clinic (courtesy National Archives of Zimbabwe)

2.2Sr Madge Dry with some of the nurses she trained (194-) [Date incomplete] (courtesy National Archives of Zimbabwe)

2.3A medical orderly treating a patient (courtesy National Archives of Zimbabwe)

2.4An outdoor African clinic (courtesy National Archives of Zimbabwe)

4.1Harare Hospital trainees (195-) [Date incomplete] (courtesy National Archives of Zimbabwe)

7.1Treatment of leprosy (courtesy National Archives of Zimbabwe)

Tables

2.1 The number of nurses in training at mission stations (1943)

2.2 A summary of government clinics and patients treated between 1936 and 1946

3.1Salaries per month: African student orderlies (1958)

3.2 Salaries: Trainee nurses (1958)

6.1 Total number of HIV/AIDS cases by year (national)

Acknowledgements

This book was made possible by the women and men who gave up their valuable time to share their stories with me. Their willingness to talk about their life experiences despite the tense political and harsh economic environment prevailing in Zimbabwe left me humbled. I would also like to thank the staff at the National Archives who, since the beginning of this project, made it possible for me to access invaluable archival documents and directed me to other material that I would have missed in the catalogues. Their assistance is much appreciated.

Over the course of writing the book, I have benefited a great deal from mentors and colleagues. At the University of Minnesota – Twin Cities, Allen Isaacman and Helena Pohlandt-McCormick were instrumental in shaping early ideas around this project. They provided a model of patience and commitment to one’s work that will continue to inspire my own intellectual and professional development. I will forever be grateful. To my colleagues, Terrence Mashingaidze, Munya Munochiveyi, Ireen Mudeka, Jones Sichali, Oswald Masebo and Eleusio Phillipe, I am glad that our paths met and thank you for the sharp intellectual engagements.

At the University of the Free State, I would like to thank Ian Phimister for his untiring support and encouragement to complete this work. I am grateful for his support and guidance. Credit goes to Rosa Williams, Andy Cohen, Rory Pilosof, Daniel Spence, Kate Law, Jackie du Toit, Neil Roos and the rest of the ISG team, who provided sharp comments and critiques that went into shaping this work. A special thank you to Ilse le Roux and Tarisai Gwena for your kindness and hard work in making my further research easier during my time with the ISG. Additionally, J. P Mtisi, P. S Nyambara. E. Kramer and A. Mlambo – my history lecturers at the University of Zimbabwe – your role in shaping my intellectual journey is duly appreciated.

I would like to further thank Manchester University Press for allowing me to contribute to their Nursing History Series, the two anonymous reviewers who took time to read the proposal and the drafts as well as the editors for their great patience in seeing this project through.

To my parents, who have been extremely supportive in all my endeavours and my siblings and their families, I thank you for your understanding and encouragement throughout this project. To my generous and loving wife Tarisai and to my daughter Anashe Chido and my son Avongwe Washe, my deepest gratitude for your multi-faceted support. The three of you have generously filled a void in my life, you are so dearly loved.

Lastly, I take full responsibility for any shortcomings of this book.

This research was funded by The MacArthur Program – MacArthur and Compton Fellowships, University of Minnesota; University of Minnesota History Department; University of the Free State Post-doctoral Research Fellowship and the University of the Free State Prestige Scholars’ Programme.

Map

Map of Zimbabwe

1

Introduction: African nurses in Zimbabwe’s hospitals

In 2008, at the height of the cholera epidemic in Zimbabwe, retired nurse Laiza Shumba visited a colleague who was working at Harare Hospital. What she saw there, as she put it, was a dire situation. The nurses were under-resourced and underpaid, and she knew they would not be able to fight the disease effectively without enough support from the authorities. In her interview with me a few weeks later, she observed that the modern nurse’s plight raises challenges from the past to an entirely new and unforeseen level:

I am not saying it was all rosy in the past. It was not! We had our own challenges during the colonial period and even in the early post-colonial era. However, I did not experience what the present day nurses are going through. To be honest, I feel sorry for them. If the situation continues like this, the profession will lose its prestige.¹

At the intersection of nursing history and the history of hospitals in colonial and post-colonial societies, this book tells the story of Laiza Shumba and her generation of nurses who entered the profession in the post-1950 period. It also places the history of the earlier generations of hospital workers centre stage; those men and women who commenced hospital work in the first decade of the twentieth century. It is thus a story of the generations of African² nurses who practised their craft in hospitals for just over a century in the former British colony of Southern Rhodesia, now Zimbabwe.³ In telling the story of these nurses, the book highlights nurses’ experiences within and outside hospital spaces.

In the course of interviewing Zimbabwean nurses about their experiences, I noticed some recurring themes: nurses’ struggles within hospitals, how African nurses constituted the backbone of the hospital system, their fight against disease (encapsulated in the phrase tairwisa zvirerwe – ‘we were fighting illness/diseases’),⁴ and the prestige associated with the profession. Nurses in Zimbabwe, to borrow from Rima Apple, ‘played vital roles in the delivery of healthcare and shaping of colonial and post-colonial relations’.⁵ Through nursing, African nurses shaped such colonial and post-colonial relations within and outside of hospitals. Hence, a history of nurses must not focus on work in hospitals alone, but also appreciate the influences and perceptions of nurses within African communities. Beyond clinical spaces, Africans held the profession in high esteem. However, the poor working conditions and inadequate remuneration, as Laiza Shumba’s observations suggest, would over time come to erode the prestige associated with the profession.

My reconstruction of this story is organised around the following broad and interrelated questions. First, what were the experiences of African nurses working in Zimbabwe’s hospitals in the twentieth century and how did their experiences change over time? Second, considering the hierarchical structure of colonial and post-colonial societies that was replicated in hospitals, as subordinates within the hierarchy, in what ways did African nurses transform these spaces to make them their own? Third, how did nurses themselves and society at large conceptualise the work of nursing? At one level, the questions framing this study enable us to examine the centrality of African nurses in the provision of care during the period under study. On another level, the questions allow us to peer into hospitals, enabling us to interrogate and flesh out nurses’ everyday work experiences. In addition, the questions open up ways of understanding and disentangling the complex relations between nurses themselves as well as between nurses and their superiors. At the same time, the questions also enable us to move beyond hospitals, exploring what the profession offered to those who practised it and societal expectations of nurses. It is important to appreciate that nurses’ struggles – within and outside clinical spaces – were part of the broader national struggles during the period under study.

Through an analytical lens that focuses on nurses’ work and what comes with that work, the book teases out the experiences of practising nursing in hospitals. Henriette Moore reminds us that work is more than the exertion of physical activity by a person over material objects or, in the case of nurses, on patients. According to Moore ‘the definition of work must also include the conditions under which that work is performed, and its perceived social values or worth within a given cultural context’.⁶ African nurses were defined by their work. Within clinical spaces, their daily work and the nature of the work structured the relations between nurses and their superiors and amongst nurses. Outside hospital spaces, the nature of their profession (work) and the associated authority that came with it, affected their social standing within their community.

The hierarchical nature of the hospital institution conditioned nurses’ work experiences. During the colonial period, race and gender informed experiences and relations. As a product of colonial bureaucracy, the structure and organisation of hospitals reflected colonial power relations, with white male administrators and medical doctors at the top of the pyramid, followed by white nurses, both senior and junior nurses. Coloured/Asian nurses followed in time. African nurses, nursing assistants and nursing orderlies anchored the bottom of the pyramid. The Africanisation of hospital administration that started in the later stages of colonial rule and ended in the immediate independent period, did little to change the structure of hospitals. Thus, colonial power relations extended beyond the post-colonial period. For the early years of independence, colonial power relations continued to inform relations between nurses and their superiors. Yet, within such an environment, African nurses carved out a niche for themselves and made workspaces (hospitals) their own. Indeed, not only were African nurses the backbone of nursing practice in colonial hospitals but, as demonstrated throughout the book, nursing practice within colonial hospitals gave African nurses an opportunity to reshape perceptions of nursing and the care economy during the period under study.

The book also underscores that, irrespective of their subordinate position within hospitals, nurses retained a degree of autonomy over the work process. This partial autonomy stemmed from the limits of nurses’ superiors’ supervision abilities and the very nature of the job. Hence, as much as nurses were under the supervision of doctors and/or matrons, having the knowledge and authority over important tasks, such as documenting patient conditions, diagnosing diseases and administering vaccines, allowed them a measure of autonomy in the practice of their work. The pioneer nurses were authorities in rural government clinics due to the relative absence of medical doctors in the countryside. The same can be said about the later generation of nurses who worked in urban hospitals in the second half of the twentieth century. Southern Rhodesia never managed to train enough white hospital workers during the period under study. This left African nurses in charge of hospitals and lent them a degree of autonomy when it came to nursing practice. A similar situation played itself out during the war of liberation in the 1970s, commonly known as the Second Chimurenga. The relative absence of senior medical personnel in the Rhodesian countryside in the 1970s at the height of the war gave nurses an opportunity to expand the scope of their practice, assert their autonomy and take responsibility of the rural clinic. This was not peculiar to Zimbabwe. The history of nursing in some parts of Africa demonstrates how nurses’ work at times included responsibilities such as diagnosis and treatment; modalities that were not typical of nurses’ everyday practice in Europe or the United States.⁷ Being the last bastion of clinical medicine in rural areas, African nurses made more decisions than before as they experienced new levels of autonomy. The ability to control the work process, whether in rural or urban hospitals, provided nurses with a degree of control over their work and hospital spaces.

Sweet and Hawkins argued that nursing history opens up ways of interrogating cultural differences.⁸ As in other parts of the colonial world, indigenous nurses were critical bridges between the colonisers and the colonised in dispensing biomedicine. As ‘middles’,⁹ to borrow from Nancy Rose Hunt, African nurses in Zimbabwe were significant cultural brokers, who, as Anne Digby and Helen Sweet showed in the case of missionary nurses in South Africa, were ‘between the modern western medical model of their training and the African traditional medicine of their patients’.¹⁰ In addition, Hunt noted that the acceptance of colonial medicine ‘was mediated by the new colonial categories of middles and the entangled objects of their work’.¹¹ Following Hunt, Digby, Sweet and others, this book also posits that, as cultural interlocutors, African nurses in Zimbabwe translated African conceptions of affliction to white medical personnel and simultaneously translated biomedicine to African patients. In fact, the establishment and running of early Christian Mission hospitals depended on the assistance of the in-house trained pioneer generation of nurses. This generation bridged the divide between white hospital workers and African patients in the early years of colonial rule. During the first decade of the twentieth century, early converts such as Tizora M. Neves received great praise in missionary records for their role in bridging the cultural divide between missionaries and African patients and in establishing missionary medical work amongst African communities. In the 1920s, Dr Gurney, a missionary doctor, was frustrated by what he perceived as Africans’ failure to use western remedies. He was also agitated by ‘many natives who cannot describe conditions with sufficient accuracy to enable a correct diagnosis’.¹² The success of Gurney’s work rested on the assistance he received from Job Tsiga. Furthermore, from the 1930s onwards, the government-trained Advanced Male Native Nursing Orderlies, as well as the formal Christian Mission-trained female nurses, continued the tradition. Both categories of nurses were products of the government’s introduction of rural clinics together with the missionaries’ quest for more formal training of nurses within their hospitals. Over a significant part of the period, African nurses continued to be cultural interlocutors. In the late 1970s and early 1980s, the problem of African patients’ incapacity to describe afflictions according to western standards continued.¹³ Flora Matondo recollected that many patients explained illness through the cultural framework. For example, claiming that illness is due to chipotswa: an affliction characterised by the sensation of an object moving rhythmically from one part of the body to another, e.g. from the left ear to the right groin. Other patients claimed that their affliction was a result of kuroyiwa (bewitchment). The patients who explained illness through a cultural framework nevertheless sought western medical help.¹⁴ This was frustrating to health personnel. The problem was not Africans’ so-called incapacity to explain affliction, rather, the predicament rested on cultural differences and the language employed in explaining illness and disease causation. Because many white doctors and nursing personnel lacked the grammar to articulate and understand the afflicted, they ended up relying chiefly on African nurses to translate the nature of the illness. In this process, therefore, African nurses drew upon cultural norms of disease causation, health and healing. Tapping into and co-opting cultural understandings of therapy in hospitals enabled them to transform hospitals into spaces that showed their expertise and transformed the hospital spaces into their own. In addition, by drawing from African cultural healing repertoires, African nurses came to terms with colonial medicine and reformulated local ideas of healing and nursing.

The manner in which the hospital functioned changed Africans’ understanding of health and healing just as young women nursing older, male patients did. Many came to terms with the idea of having access to strangers’ bodies. Tsitsi Chinamasa recollected that during her years as a student nurse, she felt uncomfortable requesting older male patients to undress for examinations. Bathing older men made her uncomfortable.¹⁵ Patients themselves also felt uneasy being instructed to undress or to have their bodies checked by younger nurses. In the 1960s at Harari Central Hospital, authorities discovered that older men were slow in recovering due to their reluctance to disclose the nature of their ailments to young nurses. It is a belief within the Shona/Ndebele culture that a patient is not supposed to reveal his/her illness to strangers.¹⁶ The patients found it difficult to divulge their ailments to women similar in age to their daughters or daughters in law. To this end, women’s work provides an opportunity to examine the health transformations that took place among Africans with the introduction of hospitals.

Based on the experiences of hospital nurses, providing care – in what nurses conceptualised as – kuriswa zvirwere (fighting diseases/illness) and kupepa varwere (nursing the infirm), my study goes far beyond the anecdotal. The history of nursing, I contend, must move beyond hospital walls to examine African nurses within colonial and post-colonial communities. An examination of nurses’ experiences beyond the clinical space makes visible the social transformations that took place in colonial Zimbabwe during the time under study. Women constitute the majority of nurses in Zimbabwe. Therefore, the study of nurses in Zimbabwe is incomplete if it fails to examine African women’s hopes and aspirations in taking up nursing. One of the central arguments I make is that because the government preferred to train female nurses, opening up nursing to African women, we must take note that these women were important historical actors who chose nursing for various reasons. Amongst other things, nursing offered new possibilities for African women who were living in a racist and patriarchal society. African women saw nursing as an avenue to secure a better life for themselves and their families. Employment opportunities through nursing contributed to the sudden and unprecedented rise in these women’s social positions. Becoming members of the new African middle class marked a change in the self-perceptions of those who worked as nurses. In the past, their fathers and subsequently their husbands primarily determined women’s positions within society. As nurses, women’s social standing was also identified by their achievement and by the degree of independence they acquired apart from male control.¹⁷

In addition, with the extension of the State Registered Nursing (SRN) programme to African women in the post-1945 period, nursing took on a different meaning for most of the women who joined the profession. It was more than a job. Africans, in this case, women, just as the earlier generation of hospital workers, took the opportunity to highlight their abilities in a racist and oppressive society. Because education was restricted for Africans in general and African women in particular, only a small number of women could qualify to enter the nursing programme. For those women, nursing was more than just everyday work; it represented what African women could achieve if given an opportunity. African nurses, as veteran nationalist Edison Sithole wrote, epitomised the progress of African people living under tough circumstances.¹⁸ For African women, nursing contributed to African society just as white nurses, who left the United Kingdom, did so to help Britain’s colonies.¹⁹ In short, privileging women’s motives for choosing nursing as a preferred, though limited, career option, prompts analysis of the social and economic changes that took place amongst African women in colonial Zimbabwe.

Centring on nurses’ work and the nature of the work process brings into focus hospitals and their culture. Nursing historian Barbara Melosh pointed out that such culture has specific language, tradition and social rules that workers (nurses) create on the job. Hence, terms like work culture, shop floor culture and occupational culture suggest coherence and structure in activities.²⁰ This occupational culture is central in guiding and interpreting the tasks and social relations of work. Furthermore, workplace culture ‘embodies workers’ definition of a good day’s work, their measure of satisfying competent performance’.²¹ Melosh further argued that nursing’s occupational culture, a product of nurses’ distinctive training, ‘provided the lore, the anecdote, and the prescription for managing the nurse’s intricate gender and race-based relationships with patients, doctors, supervisors, and administrators’.²² In this study, workplace relationships are important in analysing the experiences of nurses within clinical spaces. Nursing scholars have shown how nursing illuminates the way in which gender informs work and how this work reproduces and transforms relationships of power and inequality.²³ Undoubtedly, labour division within hospitals replicated a larger sexual division of labour. Caring for patients imitated the relationship of a mother and children; deference to doctors was structured similarly to women’s deference to fathers and husbands. Even the relationship between junior nurses and their superiors was framed within paternalistic relationships in a hospital system that privileged senior women.

These gendered and feminised ideas were transplanted to the colonies with the introduction of western hospitals and biomedicine. In settler societies such as Rhodesia and South Africa, the hospital system replicated larger racial and class divisions of labour. For South Africa, Belinda Bozzoli and Shula Marks pointed out that the cleavages along gender lines mirrored race and class divisions. Hence, relationships of domination and subordination were not just a result of inequalities between different races and classes in South Africa; there were also inequalities among men and women, and white, coloured and black women.²⁴ According to Marks, power relations ‘were made more complex by racial, ethnic and class divisions within the profession while the form that professionalism took reinforced racial and class cleavages’.²⁵ Rhodesian clinical spaces followed a similar trajectory with a fractured sisterhood informed by race and class.

Historiographical context

Considering that there is very little historical work on nursing in Zimbabwe,²⁶ African nurses and everyday work in twentieth-century Zimbabwe takes up the challenge set by Helen Sweet and Sue Hawkins in Colonial caring: A history of colonial and post-colonial nursing.²⁷ Sweet and Hawkins noted that while nursing history has shifted in its examining of professionalisation within national borders by employing a more strongly international emphasis, there is still a gap within nursing history around the role that nurses and nursing played in a country’s past. More specifically, the book’s starting point constitutes the work of nursing historians who have not only examined the various ways in which nursing and hospitals became sites of race, class, and gender and ethnic struggles, but also focused on nurses who occupied the lower rungs of the profession, in the process giving voice to those silenced in nursing historiography.²⁸ In Rhodesia, African nurses were in a subordinate position within hospitals. Even when some of them were elevated to senior positions in the second half of the twentieth century, colonial relations dictated nurses’ daily experiences. Despite their subordinate position, indigenous nurses played a significant role in administrating biomedicine. As Megan Vaughan persuasively argued, biomedicine was practised not only on Africans but also by Africans.²⁹ At the same time, African nurses translated and negotiated biomedicine to African patients. In the process, such personnel incorporated local practices and appropriated local concepts to fit biomedical practices.³⁰ While this book examines African nurses’ everyday work within hospitals, it also emphasises nurses’ experiences beyond the confines of the hospital. In doing so, the book expands upon Horwitz’s examination of the diverse motives for choosing nursing as a career,³¹ and relates childhood experiences with nursing, a neglected connection within nursing history.

The Zimbabwean case gives nursing history an opportunity to make comparison with South Africa. In fact, the history of nursing in Zimbabwe mirrors some of the key developments of nursing history in South Africa. While Rhodesia enticed health administrators from the United Kingdom, a significant proportion of white nurses and government officials who occupied influential positions in South Africa migrated to Rhodesia. In their various capacities, they brought ideologies that influenced the practice of nursing in the colony. As noted earlier, racial identities in colonial Zimbabwe, as in South Africa, affected the very nature of relations amongst nurses working in hospitals during the colonial period. An equally crucial analytical tool is gender. Like South Africa, the majority of nurses in Zimbabwe are women. Indeed, up to a particular point in South African and Zimbabwean nursing histories, men, who at times were not classified as nurses within the records, provided nursing services to their fellow Africans. In Zimbabwe, as demonstrated in the book, male nursing orderlies made up the spine of rural clinics in the pre-1950s era. In the 1970s, male guerrilla medics provided nursing services to civilians and combatants at the height of the liberation struggle. Yet, there was no formal training of male nurses until 1966.³² Even with the training of the few males as nurses starting in 1966, the presence of a formally trained male nurse within hospitals was an exception to the rule. This comes out of the nature of colonialism experienced in colonial settler